We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |


Charles G. Child III, M.D.; Arthur J. Donovan, M.D.
JAMA. 1957;163(14):1219-1229. doi:10.1001/jama.1957.02970490017005.
Text Size: A A A
Published online


• Bleeding from varices in patients with portal hypertension presents certain perplexing problems. The danger of recurrence of bleeding must be weighed against the hazards of the various types of shunting operations and the neuronutritional deficits that follow. In the individual case, portal venography and the determination of blood pressures in the portal system give valuable data. Three cases illustrate these points. In one patient an end-to-side portacaval anastomosis reduced the portal pressure from 35 cm. to 20 cm. of saline solution; bleeding did not recur. In the second patient varices persisted and hemorrhages recurred for years after splenectomy without evidence of portal hypertension; the varices disappeared and bleeding stopped after a limited esophagogastrectomy. A third patient illustrates the effectiveness of a portacaval shunt in reducing the portal blood pressure and abolishing an ascites that had not yielded to other measures. More information is needed as to the operative and postoperative hazards of shunting operations as compared with the danger of recurrent hemorrhages under improved medical treatment.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.